Adenoviral keratoconjunctivitis

Adenoviral keratoconjunctivitis
Other names: Epidemic keratoconjunctivitis, keratoconjunctivitis epidemica, pink eye[1]
Adenoviral keratoconjunctivitis
SpecialtyOphthalmology, infectious diseases
SymptomsPainful red eye, discomfort/irritation, sensitivity to light, watering, blurred vision, discharge[2]
ComplicationsCorneal scarring[3]
Usual onsetSudden in an adult[4]
Duration7-10 days, can be longer[4]
CausesAdenoviruses, commonly types 8 and 37[4]
Diagnostic methodVisualisation, viral culture (with immunofluorescence staining), PCR[4]
Differential diagnosisHerpes simplex type I, acanthamoeba, fungal infection[5]
PreventionHand washing,[4] adenovirus vaccine (military personnel)[4]
TreatmentUsually none, cold compress, artificial tears[3]
FrequencyEpidemics, common, adults>children[3]

Adenoviral keratoconjunctivitis, also known as epidemic keratoconjunctivitis, is a type of adenovirus disease presenting as an eye infection.[6] It typically begins in one eye with sudden onset of redness, watery discharge, and feeling that something is in the eye.[2] There may also be eye pain, intolerance to light, blurry vision, and swollen glands by the ear near the affected eye.[3][7] It is associated with a sore throat and stuffy and runny nose, mainly in adults.[4] In young children high fever, sore throat, ear infection, vomiting, and diarrhea may also occur.[4]

It is commonly caused by adenovirus types 8 and 37.[4] It is contagious and spread by contaminated eye examination instruments and eye solutions, touching eyes by infected people, inadequately chlorinated swimming pools, or other contaminated objects.[4] The time between contact and onset of symptoms is around 5–10 days.[4] Diagnosis is usually based on symptoms and examination.[1]

Usually, the condition is better after 7 to 10-days, with no specific treatment required.[4] Cold compresses and artificial tears may help.[3] Corneal scarring occurs in up to half of cases and the blurred vision may continue for a long time in some people.[3] The virus may remain in the eye for 2 to 3-years after recovering.[4]

Globally it is a common cause of a red eye and tends to occur in large numbers of people at the same time.[3] Adults tend to be affected more frequently than children.[4]

Signs and symptoms

Swelling around the eye, with a dropping eyelid, and redness of the eye

It typically begins in one eye with sudden onset of redness, watery discharge, and feeling that something is in the eye.[2] The eye may be very painful.[7] It then develops with intolerance to light, blurred vision and swollen glands by the ear nearest the affected eye.[3] It may spread to the other eye.[2] The condition is part of adenovirus disease, where it is often associated with a sore throat and stuffy and runny nose, mainly in adults.[4] A type of adenoviral keratoconjunctivitis in very small children can present with a high fever, sore throat, ear infection, vomiting and diarrhea.[4]

Cause

It is commonly caused by types 8 and 37 adenoviruses, spread by contaminated eye examination instruments and eye solutions, touching eyes by infected people, from inadequately chlorinated swimming pools, or other contaminated objects.[4] Onset of symptoms is generally around 5–10 days after exposure.[4] From the onset of symptoms, people remain contagious for about 2 weeks.[1]

Diagnosis

Human adenovirus type 8 epidemic keratoconjunctivitis. (A) Nine days after the appearance of the initial symptoms. The cornea of the left eye had a large area of circular epithelial defects with an irregular surface. (B) The epithelial defect widened with an overhanging edge on the tenth day. (C) The cornea of the right eye started to present with multiple full-layer epithelial defects, smaller than the ones in the left eye. (D) The previous defect of the cornea re-epithelialized, and subepithelial corneal infiltrates were observed.

Diagnosis is usually based on symptoms and examination.[1] Occasionally, it may be confirmed by cell culture (with immunofluorescence staining) or PCR.[5]

It may appear similar to herpes simplex type I, acanthamoeba, and fungal infection.[5]

  • Adenovirus in the HEp-2 cells derived from swab samples (by indirect immunofluorescence assay).
    Adenovirus in the HEp-2 cells derived from swab samples (by indirect immunofluorescence assay).

Prevention

Adequate infection control measures should be followed as prevention and to reduce epidemic AKC outbreaks.[8]

Treatment

There is currently no effective treatment of the acute phase of AKC.[1] Measures like application of a cool cloth or artificial tears may help with the symptoms.[1]

Topical cidofovir may reduce the incidence of corneal opacities, but local toxicity rules out its use. NMSO3, a sulfated sialyl lipid, has demonstrated a greater antiviral potency against adenovirus in vitro than cidofovir exhibiting minimal cytotoxicity.[9] Topical cyclosporin A (CsA) appears to be effective in for persistent corneal opacities. Topical interferon might be effective to prevent infection; though is not commercially available due to unsettled patent issues.

Topical steroids should be avoided because they prolong viral replication, frequently lead to long-lasting dry eye symptoms, and corneal opacities almost always recur after discontinuation of topical steroids.

Epidemiology

Globally it is a common cause of a red eye and tends to occur in large numbers of people at the same time.[3] Adults tend to be affected more frequently than children.[4]

References

  1. 1 2 3 4 5 6 "Epidemic Keratoconjunctivitis - EyeWiki". eyewiki.aao.org. Archived from the original on 1 February 2022. Retrieved 10 May 2022.
  2. 1 2 3 4 Burrow, Michael K.; Patel, Bhupendra C. (2022). "Keratoconjunctivitis". StatPearls. StatPearls Publishing. PMID 31194419.
  3. 1 2 3 4 5 6 7 8 9 Bawazeer, Ahmed (4 June 2019). "Epidemic Keratoconjunctivitis (EKC)". Medscape. Archived from the original on 21 April 2021. Retrieved 16 July 2021.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Shieh, Wun-Ju (10 September 2021). "Human adenovirus infections in pediatric population - An update on clinico-pathologic correlation". Biomedical Journal: S2319–4170(21)00109–8. doi:10.1016/j.bj.2021.08.009. ISSN 2320-2890. PMID 34506970. Archived from the original on 24 April 2022. Retrieved 23 April 2022.
  5. 1 2 3 Pihos, Andria M. (April 2013). "Epidemic keratoconjunctivitis: A review of current concepts in management". Journal of Optometry. 6 (2): 69–74. doi:10.1016/j.optom.2012.08.003. ISSN 1888-4296. Archived from the original on 8 November 2021. Retrieved 8 November 2021.
  6. ↑ Ison, Michael G. (2019). "341. Adenovirus diseases". In Goldman, Lee; Schafer, Andrew I. (eds.). Goldman-Cecil Medicine (26th ed.). Elsevier. p. 2163. ISBN 978-0-323-55087-1. Archived from the original on 2022-04-28. Retrieved 2022-04-27.
  7. 1 2 Flint, S. Jane; Nemerow, Glen R. (2017). "8. Pathogenesis". Human Adenoviruses: From Villains To Vectors. Singapore: World Scientific. p. 153-183. ISBN 978-981-310-979-7. Archived from the original on 2022-05-05. Retrieved 2022-05-05.
  8. ↑ Reinhard, Thomas; Larkin, Frank (28 January 2006). Cornea and External Eye Disease. google.com.au. ISBN 9783540312260. Archived from the original on 8 November 2021. Retrieved 22 March 2015.
  9. ↑ Kaneko H; et al. (2001). "Antiviral activity of NMSO3 against adenovirus in vitro". Antiviral Res. 52 (3): 281–8. doi:10.1016/s0166-3542(01)00167-x. PMID 11675145.
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